The rotator cuff is a group of muscles and tendons that help to move the shoulder and hold the joint in place and centered. Rotator cuff disorders result from inflammation or damage to the rotator cuff muscles or tendons, or inflammation of the subacromial bursa (which is a fluid-filled pad that sits under the highest part of the shoulder). The inflammation can be caused by general wear and tear that occurs with age, activities that require constant or repetitive shoulder motion (especially above shoulder level), heavy lifting, trauma, or poor posture. Serious injuries and untreated inflammation of the tendons can cause the rotator cuff to potentially tear.

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Many rotator injuries can come from normal non-traumatic activities. Many years of sitting at a desk as well as a sedentary lifestyle means that our arms are held by our side or in front of us over a desk. This creates a shortening or a lack of elasticity of the soft connective tissues of the shoulder, in particular, the rotator cuff tendons and the muscles. The muscles overtime become weaker and tighter so that they restrict normal movements of the shoulder and this restriction creates inflammatory changes of the tendons and progressive degeneration. This means that benign movements of the shoulder can lead to an injury.

The pain associated with rotator cuff problems is normally felt at the front or on the outside of the shoulder, particularly when you raise your arm or lift something above your head. You may also notice the pain more when lying in bed, particularly when lying on the affected side. Severe injuries can cause weakness of the shoulder muscles, restricted shoulder movement and continuous aching pain. There is also a potential chance of a referral pattern radiating up to the neck or down to the elbow region.

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Treatment

In addition to relieving pain, treatment is aimed at restoring mobility in your shoulder joint. The choice of treatment depends on the shoulder problem. Treatment is aimed at restoring the limited movements so that the surrounding soft tissues and joint can move freely and cope with normal activity without getting distressed. Strength and elasticity is restored so that they can acquire the length with the ability to cope with the load in every position that the shoulder is required to do.

We massage and use active releases to restore the elasticity of the muscles and tendons and we mobilise the joint to gently break-up the adhesions within the soft connective tissues of the joint (capsule and ligaments). Whilst this is happening, we commence a strengthening program initially using a theraband along with a stretching program. The patient may then progress to a more elaborate exercise program to minimise the chance of recurrence.

We strongly recommend the shoulder problem isn’t rested for too long. While you should avoid strenuous activities and lifting heavy objects, you should still move your shoulder to help make sure that you regain full use of the joint. By returning to your normal activities as soon as possible (within the limits pain), you can help prevent the shoulder joint from stiffening up and thus requiring far less treatment to restore it.

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